Multimodality treatment of intrahepatic cholangiocarcinoma: A review.

Intrahepatic cholangiocarcinoma (iCCA) is the second most common primary hepatic cancer in the United States. Currently, curative treatment involves aggressive surgery. Chemotherapy and radiation treatments have been used for unresectable tumors with some success. Optimizing the use of current and developing novel multimodality treatment for iCCA is essential to improving outcomes.

Back pain among health care workers in Pennsylvania 2002-2006.

UNLABELLED: While back pain is common among health care workers in the United States, the epidemiology of back pain is unclear. OBJECTIVE: The purpose of this study was to estimate the incidence and trend of back pain from work-related injuries among health care workers. METHODS: Data from the Pennsylvania Work Injuries and Illnesses Reports from 2002 to 2006 were analyzed. RESULTS: Estimated back injuries account for 24.6% of all reported injuries in healthcare workers in Pennsylvania. From 2002 to 2006, there was a 22.5% increase in the incidence of reported back pain in this population. CONCLUSIONS: Due to a lack of detailed reports regarding the incidence of back pain among Pennsylvania healthcare workers, it is recommended that a survey of healthcare workers who perform patient handling be completed.

Progression of secondary injury after musculoskeletal trauma-a window of opportunity?

CONTEXT: Acute musculoskeletal-injury management largely focuses on inhibiting secondary injury, although the data describing secondary injury and the timeline for its progression are sparse. OBJECTIVE: To describe the timeline and early progression of secondary injury in skeletal muscle over the first 5 h after blunt trauma. DESIGN: A controlled laboratory study with 2 independent variables (injury status and postinjury time point) in a 2 × 21 factorial. SETTING: University research laboratory. SUBJECTS: 168 male Sprague Dawley rats (250 to 275 g). INTERVENTIONS: Uniform blunt-contusion injury was caused to the right triceps surae using a drop-weight method; the contralateral limb served as an uninjured control. Both triceps surae were excised and flash frozen at 21 intervals across 5 h postinjury (8 animals, each 15 min). MAIN OUTCOME MEASURES: Cytochrome-c oxidase activity via reduction of triphenyltetrazolium chloride (TTC) to triphenylformazan. RESULTS: There was an interaction effect (P = .041) between and main effects for both injury status (P < .0005) and postinjury time point (P = .038). In the first 30 min after injury, uninjured tissues did not differ from injured tissues, and both displayed TTC reduction rates in the vicinity of 7.1 ± 0.94 µg × mg-1 × h-1. Statistical differences between uninjured and injured tissues became evident starting at 30 min. TTC reduction for uninjured tissues did not change, but injured tissues declined in a roughly linear fashion across the entire 5-h period to 4.8 ± 1.04 µg × mg-1 × h-1. CONCLUSIONS: Cytochrome-c oxidase activity, an indicator of oxidative phosphorylation and mitochondrial viability, is diminished by events that follow muscle trauma. Loss of this enzymatic activity becomes statistically evident at 30 min postinjury and continues linearly for at least 5 h. This suggests that secondary injury is a slowly developing problem of more than 5 h duration. A window of opportunity for intervention may lie somewhere within the first 30 min after injury.

Cocoa-based protein and carbohydrate drink decreases perceived soreness after exhaustive aerobic exercise: a pragmatic preliminary analysis.

The purpose of this pragmatic preliminary analysis was to examine the effectiveness of a cocoa-based protein and carbohydrate prototype drink on skeletal muscle damage and perceived soreness after exhaustive exercise. A repeated-measures experimental design was used. Common biomarkers indicative of skeletal muscle damage included creatine kinase (CK), urinary isoprostanes and inflammatory markers (IL-6, IL-8, C-Reactive Protein [CRP]). Self-reported perception of postexercise soreness was also evaluated. Seven men participated in an exercise session consisting of a 30-minute run on a declined treadmill (-10% grade). Running speed was adjusted accordingly so that participants consistently maintained 75% maximal heart rate. Drinks were ingested immediately after exercise, 2 hours postexercise, and before bed. Blood draws were sampled 30, 60, 120, and 360 minutes postexercise; urine was collected 24 and 48 hours postexercise. A perceived soreness questionnaire was administered 24 and 48 hours postexercise. The test drink had no effect on IL-6, CK, IL-8, CRP, or urinary isoprostanes (p > 0.05). However, the drink decreased the change in perceived soreness from 24 to 48 hours (p = 0.03). Consuming the drink after exercise resulted in a mean change of 2.6 +/- 6 compared to 13.7 +/- 10 for the control. In summary, the drink was effective in decreasing the level of self-reported perceived soreness after exhaustive exercise.

Premature knee osteoarthritis after anterior cruciate ligament reconstruction dependent on autograft.

Anterior cruciate ligament (ACL) reconstructions are common postoperative orthopedic conditions encountered by sports rehabilitation specialists. The rationale for reconstructing the ACL is to restore mechanical stability of the knee joint and prevent associated musculoskeletal sequelae. The selection of available autogenous graft options for surgical interventions continues to be a controversial topic in orthopedic sports medicine. Two established methods for reconstructing the ACL include using the ipsilateral patellar tendon or the semitendinosus and gracilis tendons. Both procedures yield advantages and disadvantages. However, a current outcome trend suggests that the bone-patellar tendon-bone (BPTB) procedure may serve as a catalyst for accelerating the progression of knee osteoarthritis. Such a consequence poses unique athletic health care concerns, especially with the increased incidence of ACL injuries and reconstructions among younger individuals. Therefore, implementing a semitendinosus and gracilis (STG) technique for ACL reconstruction may provide a means of decreasing the incidence of premature tibiofemoral or patellofemoral osteoarthritis in the physically active population. Sports rehabilitation specialists must be aware of this phenomenon to help sports medicine personnel and physically active patients identify expected trend outcomes with diverse ACL-reconstruction methods.

Reliability and validity of a novel muscle contusion device.

CONTEXT: Many models have been employed to replicate skeletal muscle injury associated with trauma; however, most are restricted to 1 level of severity. OBJECTIVE: To create and validate an injury-producing device that could generate multiple levels of injury severity. DESIGN: Validation study. PATIENTS OR OTHER PARTICIPANTS: Twenty-six male Wistar rats, 3 to 4 months old. INTERVENTION(S): A contusion device was developed and its ability to deliver consistent impacts was validated alone and in the presence of an experimental animal. A free-falling mass (267 g) was adjusted to the desired height (40, 50, 60, or 70 cm) and then dropped. MAIN OUTCOME MEASURE(S): Peak load, peak displacement, impulse, energy, and velocity peak were measured. Injury severity was determined using magnetic resonance imaging. RESULTS: Outcome measures observed from the device alone were different by height (F(18,136) = 21.807, P < .001, 1-beta = 1.0). Outcomes using the experimental animals were also dependent on height (F(14,102) = 68.679, P < .001, 1-beta = 1.0). Linear regression analyses indicated that height accounted for 17% to 89% of the variance. CONCLUSIONS: Mild to moderate and moderate to severe injuries can be replicated with this device, which will be useful in evaluating clinical treatments on acute muscle injury.

Magnetic resonance imaging of acute injury in rats and the effects of buprenorphine on limb volume.

The purposes of this study were to determine 1) whether magnetic resonance imaging (MRI)-based T2 mapping and measurements of limb volume can differentiate injured and uninjured tissue after blunt trauma to rat hindlimbs and 2) whether administration of buprenorphine influences these assessments. Male Wistar rats (age, 3 to 4 mo) underwent blunt contusion injury to the posterior aspect of the hindlimb; MRI was conducted at 6, 12, 24, 48, 72, and 96 h after injury. The imaging results showed that administration of buprenorphine had no effect on the T2 value {area under the receiver operating characteristic [ROC] curve: with drug, 0.869 [95% confidence interval (CI), 0.78 to 0.96]; without drug, 0.809 [95% CI, 0.72 to 0.90]} but did influence limb volume [area under the ROC curve; without drug, 0.954 (95% CI, 0.92 to 0.99); with drug, 0.713 (95% CI, 0.61 to 0.82)]. When using MRI to determine the extent of injury or to track injury over time, calculated limb volumes may lose sensitivity to detect injury, due to the intrinsic increase in volume from morphine-derived drugs. During administration of morphine derivatives, T2 maps may provide more accurate assessments of muscle tissue injury both initially after injury and over time.

Systematic review of efficacy for manual lymphatic drainage techniques in sports medicine and rehabilitation: an evidence-based practice approach.

Manual therapists question integrating manual lymphatic drainage techniques (MLDTs) into conventional treatments for athletic injuries due to the scarcity of literature concerning musculoskeletal applications and established orthopaedic clinical practice guidelines. The purpose of this systematic review is to provide manual therapy clinicians with pertinent information regarding progression of MLDTs as well as to critique the evidence for efficacy of this method in sports medicine. We surveyed English-language publications from 1998 to 2008 by searching PubMed, PEDro, CINAHL, the Cochrane Library, and SPORTDiscus databases using the terms lymphatic system, lymph drainage, lymphatic therapy, manual lymph drainage, and lymphatic pump techniques. We selected articles investigating the effects of MLDTs on orthopaedic and athletic injury outcomes. Nine articles met inclusion criteria, of which 3 were randomized controlled trials (RCTs). We evaluated the 3 RCTs using a validity score (PEDro scale). Due to differences in experimental design, data could not be collapsed for meta-analysis. Animal model experiments reinforce theoretical principles for application of MLDTs. When combined with concomitant musculoskeletal therapy, pilot and case studies demonstrate MLDT effectiveness. The best evidence suggests that efficacy of MLDT in sports medicine and rehabilitation is specific to resolution of enzyme serum levels associated with acute skeletal muscle cell damage as well as reduction of edema following acute ankle joint sprain and radial wrist fracture. Currently, there is limited high-ranking evidence available. Well-designed RCTs assessing outcome variables following implementation of MLDTs in treating athletic injuries may provide conclusive evidence for establishing applicable clinical practice guidelines in sports medicine and rehabilitation.

Therapeutic ultrasound decreases mechano-growth factor messenger ribonucleic acid expression after muscle contusion injury.

OBJECTIVE: To examine the influence of nonthermal ultrasound on mechano-growth factor (MGF) messenger ribonucleic acid (mRNA) expression after blunt trauma. DESIGN: A 2x4 factorial multivariate analysis of variance design. SETTING: University research laboratory. ANIMALS: Thirty-six 3- to 4-month-old male Wistar rats (mean weight, 280.8+/-21.5g). Thirty-two received a bilateral contusion injury to the gastrocnemius via a drop mass technique. Four were control animals. INTERVENTION: Ultrasound treatment (frequency, 3MHz; intensity, 0.3W/cm(2); continuous duty cycle) was started 24 hours postinjury and delivered for 5 minutes daily on 4 consecutive days. Treatment was on the left hindlimb and the contralateral right hindlimb was the nonultrasound control. MAIN OUTCOME MEASURES: Muscle mass (in grams) and MGF mRNA expression as measured via real-time reverse transcriptase polymerase chain reaction. RESULTS: Ultrasound had no effect on muscle mass (F(1,28)=2.723, P=.110, 1-beta=.357, eta(2)=.089). Ultrasound treatments decreased MGF mRNA expression in the treated limb compared with the nontreated hindlimb (F(1,28)=6.605, P=.016, 1-beta=.699, eta(2)=.191). CONCLUSIONS: The nonthermal ultrasound treatments resulted in decreased MGF mRNA expression after blunt trauma to the gastrocnemius muscles.